01/02/2016

"Today, sheltered from the hardships of hunger, disease, heat and cold that stalked human life for centuries, some people have lost their capacity to deal with real difficulty. Growing up in a protected palace of comfort, they have lost their ability to walk through pain."

Former Navy SEAL Eric Greitens' book, Resilience: Wisdom For Living A Better Life, speaks to the need for leaders to cultivate the inner strength to repetitively try, fail and always start over.

I found this commencement speech -- Make Your Bed - - by another Navy SEAL, Adm. William H. McRaven, ninth commander of U.S. Special Operations Command, to be an EXCELLENT refresher for any tired leader entering the New Year.

Personal policies are an established set of simple rules that guide your decisions and actions. On the surface, they offer a gentler way of saying no, as in: “I don’t take work calls on Saturdays because that’s my time with family.” On a deeper level, they encourage reflection, help to define priorities and aid decision-making, especially with in-the-moment requests. They can stop you from defaulting to that regretful “yes.”

Here are 3 Steps to make the Change:

Take time today to reflect upon the year just finished and the one ahead.

Write down a hand full of specific behaviors you want to change (no more than 3) and this time state them as a personal policy instead of a New Year's Resolution or good intention.

Then share your new policies with two or three people close to you and you're on your way to a happier, more productive 2016 - - by saying Yes to what really matters to you!

11/04/2015

Tony Evans, MD, FAAFP recently shared an important insight for healthcare executives trying to align with their physicians in the New World of Healthcare.

Tony is CEO of the Iowa Healthcare Collaborative, "a provider-led and patient-focused nonprofit organization dedicated to promoting a culture of continuous improvement in healthcare [by] putting healthcare providers in a leadership position to drive clinical improvements and accelerate change."

Here was his insight:

Fee For Service is a "Fishing Tournament." The winner works alone to land the most and biggest fish (volume).

Value Based Purchasing is a "Football Game." It's a team sport. There are special rules that require coordinated play among all the players. They win or lose together.

Physicians are the Ultimate "Fishermen." They have learned to play solo. "Team" is not part of their normal life. But they are fast-learners and can to learn how to play Football instead!

Here's the application:

Health system executives who see the New World coming quickly realize they need physicians to help them prepare for the game.

Don't start playing Football before creating a Training Camp for the high-potential physician leaders in your midst.

Start with the fundamentals of how to THINK and ACT together as team mates - - before you try to teach the techniques of blocking and tackling (population health management, etc.)

You might be surprised at how much you and your team need to move from Fishing to Football just like your physicians do!

10/21/2015

That word - - Compromise - - often elicits an angry response. Some think it means sacrificing one's principles on the alter of expediency.

In fact, compromise is a valuable way to resolve conflict, a fact of life in any relationship. What sets it apart is its ability to find a way forward when the the clock is ticking and the only alternative is "all or nothing."

The constitutional republic called the Unite States of America was intentionally designed by its founders to require compromise in order to reach decisions among opposing views. Without compromise, nothing happens. It's part of negotiation, it's "the art of the possible." Both parties agree to get half a loaf and come back tomorrow to try again.

Today's Wall Street Journal included the following quote by Ronald Reagan that tells it best.

"There were still some hard feelings toward me left over from the campaign, when I’d gone out of my way to say I thought the professional politicians in Sacramento and I were natural enemies: My loyalty was to the people, not the political establishment, and I had said so fairly pointedly. Although that sentiment never changed, I realized after a while that to accomplish what I wanted to do swimming upstream against a current of opposition legislators, I’d have to do some negotiating with them. . . .

When I began entering into the give and take of legislative bargaining in Sacramento, a lot of the most radical conservatives who had supported me during the election didn’t like it. “Compromise” was a dirty word to them and they wouldn’t face the fact that we couldn’t get all of what we wanted today. They wanted all or nothing and they wanted it all at once. If you don’t get it all, some said, don’t take anything.

I’d learned while negotiating union contracts (as president of the Screen Actors Guild) that you seldom got everything you asked for. And I agreed with FDR, who said in 1933: “I have no expectations of making a hit every time I come to bat. What I seek is the highest possible batting average.”

If you got seventy-five or eighty percent of what you were asking for, I say, you take it and fight for the rest later, and that’s what I told these radical conservatives who never got used to it."

The reason Rep Paul Ryan is being courted to step into the role of House Speaker is because he understands the necessity of compromise. He's getting pilloried for it by some in his party. It will be interesting to see if it has become a forgotten art to his colleagues. The alternatives aren't pretty.

04/07/2015

In my work with leaders, I find that one quality often makes the difference between success and failure: Resilience. "There is a path through pain to wisdom, through fear to courage, through suffering to strength, and it requires resilience ... the ability to transform adversity into an enjoyable challenge."

That's why I am recommending to my clients a powerfully insightful book entitled, Resilience: Hard-Won Wisdom for Living a Better Life, authored by a Rhodes Scholar, Boxing Champion, Humanitarian Leader and Navy SEAL, named Eric Greitens.

The following is an excerpt that is representative of the kind of uncommon wisdom that has been learned by leaders across history:

History is full of those who have tried to escape the burdens of responsibility. At the extremes, some have even traded their freedom for obedience to tyrants. One of my favorite streetwise philosophers, Eric Hoffer, studied the reasons why people voluntarily give away responsibility and join mass movements and mobs. One quote he collected came from a young German who explained that he joined the Nazi party to be "free from freedom."

The desire to avoid responsibility can be overwhelming. That desire is so great that it has fed some of the greatest epochs of tyranny and acts of brutality the world has ever known. It is a desire so pervasive, so delicious, that tyrants have been able to rely on it in every era of human history. Responsibility is a heavy burden.

But responsibility also offers power. If we take responsibility for ourselves, we become not victims, but pioneers. The victim falls prey to fear and delights in blaming others. The pioneer forges his own path; more difficult, but more rewarding.

So you ask yourself: Am I willing to take responsibility for my life, in word and in deed? If not, your chances of living a rich and fulfilling life are almost zero. If so, you have the potential for a joyous journey ahead.

12/06/2014

Physicians are stepping into leadership roles in hospitals and health systems. Many observers predict health system CEOs in the future will be predominantly physicians. But too many of them are unnecessarily failing.

As a career health system executive, CEO and now strategic advisor to healthcare leaders, I’ve noted a fascinating trend in how physicians actually perform as leaders. I call it the “Tale of Three Tables.”

Health systems are searching for effective physician leaders to fill a litany of institutional roles: chief medical officer, VP of medical affairs, chief clinical informatics officer, chief of clinical operations … the job titles vary. This stems largely from the shift to value-based payment by CMS. The clinical quality and patient safety metrics that now impact the system’s revenue cycle require a new kind of clinical redesign, one that non-clinical executives cannot lead. This illustrates the First Table: Doctors being invited to the executives’ Table to help redesign the health system.

Executives traditionally looked to their medical staff leaders for help. Nearly every health system has experimented with some form of “physician leadership academy” to develop leaders from within the medical staff. These programs meet with varying results, but they represent the Second Table: executives coming to the medical staff’s Table, trying to affect change inside the walls of the hospital through the mechanism of the medical staff.

In the Old World of healthcare, this made sense. The name of the game was to refer patients to specialists who admitted them to the hospital, and the focus was on building service volume. The medical staff was the only forum to affect change.

But in the New World of healthcare, the name of the game is “population health management,” turning the focus to value, teamwork and coordination of care inside and outside the hospital. Medical staffs are ill equipped to manage such care.

This reality has spawned a new concept: the “clinically integrated network” (CIN) of physicians, working in partnership with each other, and often with hospitals. There are 2 methods of integration. One is the employment of physicians by hospitals (i.e., “financial integration”). The other is the creation of a legal structure that enables independent physicians to “clinically-integrate” by creating a new business that assumes and manages financial risk through better-coordinated clinical care.

The important difference is that, unlike the hospital or the medical staff, the CIN is a new joint-ventured business. It is the Third Table, where physician leaders and hospital leaders partner to run a new business in a very interdependent manner.

The people sitting around these 3 Tables are not always aware that the role of a physician leader, and his/her relationship to their hospital executive partners, is very different at each Table. Attending to one’s “Table Manners,” therefore, becomes important!

The First Table: Physician Leadership in a HospitalHistorically, executives managed hospitals, and medical staffs were granted privileges to practice there. This often created a contentious relationship. The New World of healthcare requires a fundamental redesign of the health system, and physician leaders engaged in this work can serve as “translators” between clinical and non-clinical staff to find better clinical ways to serve patients and generate the financial margins the system needs. Chief Medical Officers become the first line of relationship between management and clinicians to set the agenda for advancing clinical quality and patient safety. It works well for the hospital clinicians, such as hospitalists, nursing, and hospital-based physician services. But the autonomy of the independent physician members of the medical staff can militate against the chief medical officer’s efforts to drive change.

The Second Table: Physician Leadership in a Medical StaffAs hospitals become accountable for the outcomes of the care of patients, management usually turns to the medical staff officers for help. Eventually, everyone realizes that a medical staff is not designed to change the clinical and business practices of its members. Its primary purpose is to set and preserve standards of quality for membership on the medical staff. Managing “pedigree” is what gets the attention - - proof of education, training and certification necessary to be privileged to practice in the hospital. Managing “performance” is limited to monitoring quality and patient safety practices and advocating for compliance with minimally required standards.

No independent physician would entrust the management of his or her private practice to the medical staff. It isn’t designed to run a business. Yet in the New World of Healthcare, running a business that assumes the risk for the management of a population’s health is exactly where we are going. A new approach is needed.

The Third Table: Physician Leadership in a Joint-Ventured BusinessThe new work at the Third Table is managing the Business Performance of physicians -- keeping referrals in-network, assuring high patient satisfaction, and following agreed-upon clinical protocols based upon best evidence-based practices. This is Population Health Management, and it will require a litany of new business competencies that combine both the institutional resources of the health system and the collaborative leadership capacity of physicians:

Automated Care Management: HER, linked from inpatient to ambulatory, with best-evidence based protocols

Reduction of Inpatient Readmissions

Managing cost and utilization of resources across the continuum of care

Improvement of Patient Compliance

Managing Clinical Quality Metrics by provider

Increasing Patient Engagement

Stratification of patients and targeted interventions to the right people

The Irreducible Ingredient for Success: LeadershipOrganizational structures to achieve legally compliant clinical integration are easier to create than is the leadership capacity required to implement and lead those new enterprises. Without effective leadership - - particularly physician leadership - - the best strategies will flounder and fail.

Leaders rarely fail because they don’t know what to do. They fail because of how they do it. “Behavioral competencies” (emotional intelligence and relationship skills) more than “technical competencies” (knowledge of finance, operations, etc.) distinguish the most effective leaders. Recent research reveals that the behavioral competencies needed by physicians to be effective leaders are not the same as for non-physician leaders. Collaboration, political acumen, motivating others and adaptability are the relationship skills that are critical to the success of physician leaders, and are qualities that the research shows are less naturally evident among physicians than the general population. But they can be learned. And the way physicians learn best is through an experiential rather than a didactic process.

The winners in The New World will emerge where executive and physician leaders come together as equal partners around The Third Table with the right Table Manners. And effective physician leaders will be a key to their success.

Eric Norwood, FACHE, is President of CenterPoint Insights, a strategic business advisory firm to healthcare leaders based in San Diego. He is a career healthcare executive and a member of the MEDI Leadership team of executive coaches, the nation’s leading leadership development firms dedicated to the healthcare industry.

11/13/2014

For my friends in healthcare leadership, a clinically and financially integrated system of care, with effective and engaged physician leaders, can create great quality/value and sustainable financial results.

Evidence: today's article on Kaiser (below). This is an organization that has made wise investments in information technology, physician integration and evidence-based care. It has it's own problems, but this is what the future must look like.

Kaiser Hospitals, Health Plan post net income of $997M in Q3

Written by Ayla Ellison November 11, 2014

Oakland, Calif.-based Kaiser Foundation Hospitals and Kaiser Foundation Health Plan have reported combined operating revenue of $14.2 billion for the third quarter of this year, up from the $13.2 billion recorded in the same period of 2013.

Kaiser's operating income grew to $766 million in the third quarter of 2014, compared to the $518 million it posted during the third quarter of last year.

Kaiser reported a decrease in non-operating income for the third quarter of this year, which fell from $241 million in the third quarter of 2013 to $228 million in this year.

Kaiser's net income for the third quarter of 2014 was $997 million, up from the $635 million it posted in the same period of last year.

"We continue to improve on quality, service and affordability and we continue to see positive results," said Bernard J. Tyson, chairman and CEO of Kaiser.

11/07/2014

I couldn't agree more with the following quote. The undeniable truth in healthcare is that no amount of medical intervention can counter-balance the damage Americans do to their own health...

In answer to the question: If you could solve one problem in healthcare tonight, what would it be?

Stephen Mansfield, PhD, president and CEO of Dallas-based Methodist Health System said:

"About two years ago, the National Research Council issued a report funded by the Institutes of Medicine and Health. It was a 16-nation longitudinal study to answer this question: Why do Americans spend more money per capita than the rest of the industrial world on healthcare, but our health metrics lag those of other countries?

The answer was not anything to do with what we reformed in healthcare, if you will. The fundamental answer was about the health status of Americans. Shockingly, what they discovered was that the U.S. is either the worst or very near the bottom for most public health measures. The U.S. health disadvantage spans many types of illness and injury.

When compared with the average of peer countries, Americans, as a group, fare worse in at least nine health areas:

1. Infant mortality and low birth weight

2. Injuries and homicides

3. Adolescent pregnancy and sexually transmit¬ted infections

4. HIV and AIDS

5. Drug-related deaths

6. Obesity and diabetes

7. Heart disease

8. Chronic lung disease

9. Disability

If I could fix one thing, it would be that Americans accept personal accountability for their individual health. Most of the nine conditions listed above are autogenic. I think it's a conscious decision that people need to stop smoking, eat less and exercise more. No amount of delivery system reform can offset the impact of our declining health status as Americans."

11/01/2014

As I work with client leaders on improving their performance, slowing down and "thinking about one's thinking" is always an early conversation we have. That's why I found this article from the Wall Street Journal (11/1/14), that plays off the theme of Daylight Saving Time, to be such a fun read.

"Now" really is a slippery business ....

The change-over from daylight-saving time this weekend reminds me of a long-ago conversation with a business colleague from India. He found the notion of our biannual time shift both novel and disturbing.

“You can’t do that,” he said. He felt that this arbitrary manipulation of time runs counter to nature, which is surely true. “How do we know that we are here now, and not an hour ago?”

“Now” is a slippery business, an ever-moving sliver of time sandwiched between what has just happened and the not-yet. The past represents an infinite series of nows endlessly arriving and departing, gliding past their sell-by date with nary a backward glance. The future is forever heading this way, alighting for a moment to become now, and then retire into the past.

ENLARGE

CORBIS

The current, salutary vogue for mindfulness bids us to focus on the moment, rather than have our thoughts kidnapped by ruminations on the past or concerns about the future. Mindfulness allows an individual access to a personal, subjective now, a portable personal sanctuary from the polyrhythmic drumbeat of change. Some day I shall try it.

Then there is the now of mindlessness. This altogether noisy now—the digital Babylon of the new, novel, momentous, scandalous, and sensational—endlessly colonizes our attention via the Internet, Twitter , TV, radio, news, popular entertainment, and advertising. Clicking and flicking, we are sucked willy-nilly into a swirling vortex of data, opinion and personalities, a psychic maelstrom devoid of perspective and reflection.

Mass media—and we, their faithful masses—provide a surrogate reality we engage with cognitively and emotionally. Information, which should teach, enlighten and inspire us, has, as social critic Neil Postman noted, “turned into a deluge of chaos” and “information no longer has any relation to the solution of problems.”

We live in a quandary of fight-or-flight hyper-arousal, stressing our bodies and minds, narrowing our vision and producing “auditory exclusion,” so our hearing is reduced to our inner screams. What you will rarely encounter in our media’s iCloud of Unknowing is the past or a sense of tradition.

Albert Einstein called this the “modernist’s snobbery,” observing, “Somebody who reads only newspapers and at best the books of contemporary authors looks to me like an extremely nearsighted person who scorns eyeglasses. He is completely dependent on the prejudices and fashions of his times, since he never gets to see or hear anything else.”

Since now is the moment when we are most fully alive, do you really want to spend it in the company of pixels?

We discover something surprising once we step away from the carny fairway of mass media, and meander through the great works of the past. Whether we are listening to Mozart, gazing at a Georgia O’Keeffe painting, pondering Confucius, or reading the “Odyssey,” we are struck by the newness and nowness of the experience.

As G.K. Chesterton wrote: “Tradition means giving votes to the most obscure of all classes, our ancestors. It is the democracy of the dead. Tradition refuses to submit to that arrogant oligarchy who merely happen to be walking around.”

Mr. Ball is chairman of the W. Atlee Burpee & Co. and past president of the American Horticultural Society.

09/26/2014

I'm fascinated by Lindsey Dunn's recent posts on the research around innovation that shows what really works is less about the change model and more about how innovative firms empower employees to make daily adaptations within the framework of a disciplined model of analysis. See previous blog post below on the topic of Adaptive Design. A higher order of leadership will be required to create this kind of culture in healthcare organizations, that are highly compartmentalized and resist change when it deviates from "The Book."